To ask the Secretary of State for Health when he last met representatives of the Royal College of Nursing to discuss nurses' pay.

I last met representatives of the Royal College of Nursing formally on 1 February when I informed them of the Government's decision on the 1990 review body reports.

Does the Secretary of State agree that there is a lack of confidence in the clinical grading appeals procedure and that matters will get worse, because there are fewer members of the slimline health authorities to hear and determine appeals? If NHS trusts are set up, there is even the prospect that the appeals procedure and clinical grading will disappear altogether in NHS hospitals. What does the Secretary of State propose to do, first, to speed up the appeals procedure and, secondly, to restore confidence in the system and thus morale in the profession?

The situation on grading appeals is something of a disgrace and it is entirely the fault of the nursing trade unions. [HON. MEMBERS: "No."] Yes, it is. When we first drew up the new grading arrangements, I put it to the nurses' trade union leaders that the existing appeals system would not work when dealing with all the appeals, because each individual case is dealt with as though it were a magistrates court hearing—one by one. I invited them to take part with me in discussions about streamlining the appeals procedure, but they refused. They preferred the existing Whitley council procedures. I hope that they will reflect upon that and that they will come back and have some sensible discussions about a proper appeals procedure. I have always suspected that some of the trade unions, at least, prefer the nurses to be left with a sense of grievance which they can play upon rather than tackle the problem of getting the gradings right.

May I advise my right hon. and learned Friend that last Saturday my wife went back to Hammersmith hospital for the 25th anniversary reunion of the nurses who, with her, went to that hospital in 1965? During that visit they were amazed to discover that there were twice as many nurses on the wards and that many patients were sent home for the weekend due to the improvement in clinical techniques and methods. Does not that demonstrate not only that there are more nurses but that when the Government's reforms are in place—[HON. MEMBERS: "Get on with it!"]—and these appeals are out of the way there will be every opportunity for the nursing profession to establish itself much more, which will enable nurses to feel that they have a much greater relationship with the hospital where they work?

My hon. Friend's wife may have had the misfortune to work in the national health service during the years when a Labour Government allowed nurses' pay to fall 21 per cent. behind inflation. It is now 40 per cent. ahead of inflation since we came to office. The profesesion is becoming well paid and much better staffed. The grading system gives nurses a much better career structure, as all nurses would recognise. It is high time that we got rid of the anomalous appeals system so as to enable the grading structure to work. Nursing is now a better-staffed and better-paid profession, with a better career structure than ever before. Nurses will get a great deal out of our improved and reformed national health service.

rose—

Order. I request hon. Members to ask brief supplementary questions. Then we shall get further down the Order Paper.

To ask the Secretary of State for Health what representations he has received regarding funding arrangements for the Government's community care proposals.

To ask the Secretary of State for Health what progress has been made on the implementation of the community care proposals contained in the National Health Service and Community Care Act 1990.

To ask the Secretary of State for Health what representations he has received from local authorities regarding the Government's proposed changes in the organisation of community care.

To ask the Secretary of State for Health what representations he has received from organisations on the new arrangements for community care; and if he will make a statement.

We have received many representations on all aspects of our community care proposals. Those views informed the Government's decision on the phasing of community care and the local authority settlement announced by my right hon. Friend. the Secretary of State for the Environment on 19 July. The implementation of our proposals is continuing to the timetable outlined by my right hon. and learned Friend the Secretary of State in his statement to the House on 18 July.

Is the Minister aware that many poll-tax-capped authorities such as mine in Barnsley are in considerable chaos following the collapse of the Government's proposals for community care? They are having to make cuts of up to £1 milliion and will face further cuts. Has the Minister discussed that in detail with the Department of the Environment to ensure that there will be adequate funding for those authorities next year?

There is no reason for the hon. Gentleman to blame the difficulties of his local authority on the decision to phase the implementation of the full community care proposals. It is clear that his local authority, and many others, will be able to develop their plans further and improve the management of their services. The fact that his authority has been charge-capped suggests that it could well invest some time in ensuring that it has the cost-effective and efficient services for the community once the policy is fully implemented.

I remind the Minister of the letter that I sent her colleague the Secretary of State on 25 September and the acknowledgement that I received on 28 September. Attached to that was a letter from my constituent, Mrs. June Cadman, who cares for 70 mentally handicapped people, in which she explained the hardship faced by the people in her charge. The letter also contained an appeal for assistance for Leeds city council and Wakefield city council social services department.

There is a project under way in the hon. Gentleman's constituency, involving the regional health authority, the housing department and the local authority, for the relocation of mentally handicapped people in the community. I am sure that my right hon. and learned Friend will reply to the hon. Gentleman's letter shortly. There is much to be done in the provision of care for mentally handicapped people and I am pleased that the hon. Gentleman is as concerned as we are to ensure that services for this needy group improve.

As the Government did not think that community care in Scotland was worth a statement last July, when they announced the two-year delay, what advice is the Minister giving her right hon. and learned Friend the Secretary of State for Scotland, as there is much difficulty among local authorities in Scotland which are strapped for cash because of Government cuts and the inefficiency of the poll tax? A two-year delay in implementing community care looks extremely optimistic.

I urge the hon. Gentleman to speak swiftly to my hon. Friend the Minister of State, Scottish Office, who announced on 26 September the full plans for implementation in Scotland. It would be presumptuous of me as an English Minister to make further comment on plans for north of the border.

Where is the caring face of a Government who delay implementation of community care and starve the system of money for vulnerable groups such as elderly and disabled people? What is the Minister doing to bridge the financial gap between social security benefits and the costs of community care, or between revenue support grant and the costs of community care for local authorities? If the Minister tries to implement this scheme on the cheap she will simply create a recipe for social disaster.

Personal social services spending has increased by 47 per cent. in the past 10 years. That is a substantial increase, quite apart from the extra money available through the social security system. My right hon. Friend the Secretary of State for Social Security has made it clear that he is considering closely the income support questions. This year's settlement for local government would be regarded by my hon. Friends as generous and even Opposition Members would regard it as fair.

Is my hon. Friend aware that in Derbyshire the postponement of the community care reforms was met with a great sense of relief, because Derbyshire county council was nowhere near ready and implementation too soon would have put many people's lives and welfare at risk? Is she further aware that the first action of Derbyshire county council in response to poll tax capping was not to cut its administration, its local government newspaper or its publicity, but to cut entirely the grant to the Derbyshire coalition of disabled people?

That is yet another item in the catalogue of appalling decisions made by Derbyshire county council, which I understand has increased its staff by 8,000 since the Labour party took control. It is clear that many local authorities need those two years. The Select Committee on Social Services made it clear that there is a pressing timetable to implement the changes by next April and I have no doubt that health authorities, voluntary organisations, the private sector and local authorities will need to spend that time training and thinking through the management and cost-effectiveness of their proposals for care in the community.

When considering funding, will my hon. Friend bear in mind the far greater cost-effectiveness of the voluntary sector in providing community care, especially for the mentally handicapped?

Once again, my hon. Friend leads me to comment on the comments of my hon. Friend the Member for Derbyshire, South (Mrs. Currie) about Derbyshire. Local authorities whose first decision is to cut support for the voluntary sector are thoroughly misguided. The voluntary sector has an excellent tradition of providing care in the community. That is why, for example, we especially identified the voluntary sector to support drug and alcohol misusers in the new specific grant announced by my right hon. and learned Friend the Secretary of State in July.

Is my hon. Friend now able to put at rest the genuine worries about funding of those running halfway houses for people coming out of alcohol and drug detoxification units? Without that service, it is difficult for such people to find their way back into a real life in the community.

My hon. Friend rightly identifies that especially needy group, who are costly in terms of services and who most certainly need a development of provision. He will know that there has been careful discussion with those organisations, which resulted in the specific grant announced in July. We believe that it will be possible for their valuable services to grow and to develop.

As these will be the last health questions before the uprating statement, can the Minister tell us what hope there is for all those residents on income support who now find that they cannot pay what their private home charges? What does she have to say to those elderly people who have had their personal allowances confiscated, who cannot buy toothpaste or newspapers and who cannot pay for stamps, and who still cannot pay the weekly cost of their home? How can she defend the double standard by which those on income support are put in the shared bedrooms with the poorer services? As it was the Government's decision to delay the community care programme for two years, what do Ministers intend to do for all those elderly and disabled residents who cannot wait until 1993 to pay this week's bill and are likely to be turned out if they try?

The hon. Gentleman knows full well that matters of uprating are for my right hon. Friend the Secretary of State for Social Security. However, it remains the case that local authorities will continue to make plans for care in the community. We remain committed to a mixed economy of care. It is important that local authorities, voluntary organisations and the private sector provide for the frail and the vulnerable. The hon. Gentleman always speaks as though resources were no object. One has only to consider—I hope that the poor and the vulnerable will do this—the record of the Labour party when in government. There has been a substantial increase in resources. I can make no further announcements without anticipating the comments of my right hon. Friend the Secretary of State for Social Security.

To ask the Secretary of State for Health what progress has been made on the implementation of the Children Act 1989.

We are consulting on the regulations guidance and rules of court necessary to implement the Act on 14 October 1991–363 days away. A comprehensive training and dissemination programme is under way.

I am grateful to the Minister for that reply. As the Children Act 1989 came about partly as a result of events in Cleveland, does the Minister agree there are now proper multidisciplinary procedures in Cleveland for the handling of alleged child sexual abuse cases? Is not it a fact that the Cleveland child abuse crisis is at an end? Given the situation in Cleveland, is not it a pity that other authorities are acting as if we had never passed a Children Act through this Parliament? Would not it be helpful if we could advance the date of implementation from October 1991?

I fear that it is not possible to advance the date from October 1991. The training programme, involving social workers, court staff and many others, will clearly be taxing for them to implement by that timetable. However, I can confirm that the social services inspectorate's report on Cleveland, which was published on 7 June this year, made it clear that good progress has been made, especially in the area of inter-agency working. It is essential that the lessons are learnt time and again that effective child protection means effective and trusting communication between local authorities, police departments, education departments and health departments. Cleveland has made great strides forward and I hope that many other local authorities will learn those lessons and ensure that they have the same working practices.

Will my hon. Friend take it from me that, far from having gone away, the spectre of Cleveland has raised its head again this week? One of the two doctors at the heart of the whole affair, Dr. Wyatt, is now being systematically helped by his cohorts of two or three years ago in his efforts to get his job back in its previous form—which involved diagnosing children as sexually abused and thereby causing much distress to children, parents and grandparents in my constituency and throughout Cleveland. Will my hon. Friend make every effort now, today, to see that this attempt is knocked on the head straight away?

I well understand the concern that my hon. Friend has expressed. I can assure him that steps have already been taken by the health authority to resolve the matter. None of us can underestimate the seriousness of the situation that arose in Cleveland, but I believe that the lessons have been learnt. The important point is that the information should be disseminated to ensure that other local authorities across the country learn those lessons—to protect children and, above all, to respect the role of parents.

Does the Minister accept that there will be profound disappointment at the fact that, following Royal Assent, an Act which arose from a great deal of consensus on both sides of the House is to take two years to implement? As the Government have declined to accept the views of the Central Council for Education and Training in Social Work, precisely what proposals do they have for essential training and what progress have they made in their commitment to family courts?

I believe that it is rather naive to think that the Children Act could be implemented in its full complexity any faster than is proposed. For example, 80 sets of regulations have to be produced. We are just producing the 20th issue of draft guidance, out of a collection of 30. It is a major task, involving local authorities, voluntary organisations, the police, health authorities and many others. We have a full training programme under way and £10 million worth of resources, in a ring-fenced sum, have been committed to ensure that that training takes place.

My hon. Friend is correct that the Children Act is an extremely complex piece of legislation, and it is probably one of the most important to emerge from Parliament this decade. I am sure that she is aware that practitioners in the field are enthusiastic about the provisions as they learn about them, but is she also aware that there is genuine concern that there may be insufficient resources to implement the proposals correctly? Can she give an assurance that resources will be available?

We are committed to ensuring that the Children Act is fully and effectively implemented. None of us can tolerate the existence of child neglect and abuse in our modern society. We have fewer children in care, but there are many children on the at-risk register. It is incumbent on us all—whether as politicians in local or central government or as members of the community—to protect those children. We have a major training programme, and the other resource aspects are the subject of regular discussions between the Department and the local authority organisations. I cannot give any further information about the personal social services allocation until after the autumn statement next month.

rose—

Order. We are making rather slow progress this afternoon. [HON. MEMBERS: "It is the Minister's fault."] I am anxious to get on.

To ask the Secretary of State for Health what steps are taken by his Department to monitor the ability of individual local authorities to carry out their statutory social work functions.

The Department's social services inspectorate keeps the Department informed about the provision of personal social services by individual local authorities.

Does the Department of Health read the reports and take action based on them, because it seems to me that the Department has little idea of what goes on in local government? For example, when the hon. Member for Derbyshire, South (Mrs. Currie) asked a question it seemed that she had also written the brief from which the Minister gave her answer, as it did not relate in any way to the problems and needs of Derbyshire. What extra money will be provided for the function and operation of the Children Act? The local authorities concerned have asked for £140 million. Will anything like that sum be available?

The information about what happens in Derbyshire comes from our "Key Indicators" document. That valuable document, which we produce annually, gives information about precisely how local authorities are spending their resources. In Derbyshire, one in three people over 75 receives a home help, free of charge. I do not believe that that is targeting resources or looking to value for money. That does not show a sense of responsibility in the provision of services.

In monitoring the social work functions of local authorities, has my hon. Friend the Minister had an opportunity to consider the way in which the London borough of Southwark discharged its duties at Grove Park children's home? If the disclosures in The Sunday Correspondent magazine are correct, is not it evident that children in the so-called care of Southwark are at even greater risk than if they were not in Southwark's care?

My hon. Friend has mentioned that home, which is in his constituency, to me before. The outrage and horror of many who saw precisely what was happening at the Grove Park children's home is shared by us all, and I am pleased to say that the home has closed. I have asked the social services inspectorate to report to me urgently on the provision of residential care for the difficult, turbulent bunch of teenagers in the capital cities. The easiest ones to foster are fostered, but residential homes have to cope with an extremely difficult and troublesome group. We look to the social services inspectorate once again to report back on that and I will certainly have urgent discussions with my hon. Friend the Member for Dulwich (Mr. Bowden) about it.

To ask the Secretary of State for Health when he proposes to visit the Sanderson hospital, Gosforth.

I have no immediate plans to do so.

Does the Minister accept that the Sanderson hospital is the last long-stay hospital for the elderly in Newcastle which does not face closure? It is part of a hospital group—the Royal Victoria infirmary—which is dithering over opt-out and has to make panic cuts to save £400,000 of overspending up to August. The site would make wonderful executive housing, or can the Minister assure us that there is still a place in the NHS for small kindly hospitals which care for patients who cannot easily be packaged or priced?

I am not sure whether the hon. Gentleman was advocating the sale of the site for high-value executive houses, but I assure him that it is NHS policy to continue to use the Sanderson hospital for the care of the elderly, for which it currently has a distinguished record.

To ask the Secretary of State for Health how many practices have now expressed an interest in joining the general practitioners' fund-holding scheme; and how many he estimates will meet the eligibility criteria and be ready for fund holding in April 1991.

To ask the Secretary of State for Health if he will make a statement on progress being made with applications for practice budgets for general practitioners.

Around 350 practices are preparing for fund-holding status from 1 April 1991, and I have been much impressed by the quality and commitment to the scheme of the practices concerned.

Does my right hon. and learned Friend agree that, while a tiny minority of doctors continue to dispense their own brand of politics, the vast majority are playing an increasingly active part in the delivery of better health care throughout the country? Is it true that on the Isle of Wight a high percentage of doctors have applied to become fund holders?

I am glad to say that on the Isle of Wight three practices have been attracted by the idea of having much more control of how NHS money is spent on the isle. Those three practices cover about 30,000 of the residents, which is about one quarter of the population, so there is a particularly high level of interest on the isle. I also agree with my hon. Friend that the experience of fund holding and of the contract is proving very beneficial. Contrary to all the inventions of last year, the amount of time spent with patients is increasing, the amount of minor surgery is increasing, the amount of time spent on health promotion is increasing and the number of practices carrying out child surveillance is increasing. The number of staff and nurses employed by the practices has increased and they are all earning more money. No doubt the fund-holding practices in the isle intend to add to those achievements if they proceed with their applications.

Is not the approach that we should follow in respect of GPs' practice budgets one of slowly, slowly catchee monkey? Surely the objective is that we should get the finances to where the patients are and give the clout to general practitioners' practices. Would my right hon. and learned Friend care to contrast that with the full-blooded enthusiasm of Opposition Members to continue with a vast centralised bureaucracy?

The pace at which we proceed with fund holding is being determined by the rate at which GPs come forward to volunteer for the scheme. We have 350 practices still actively preparing for next year and many more practices are interested in coming along the year after that. They include some of the people who represented doctors in last year's rows about the scheme and the British Medical Association has now set up a separate group to represent those fund holders, which shows that we are winning converts in quite a lot of places.

To ask the Secretary of State for Health if he will pay a visit to Southend-on-Sea to inspect the hospital services.

I have no immediate plans to do so.

Is the Minister aware that, for many years, our excellent hospitals in Southend have had to cope with being seriously underfunded in comparison with other districts because they happen to be in an overfunded region? As a new system of funding based on capitation is coming in in April, can the Minister assure Southend that that fairer system will result in something being done about consistent underfunding?

I can confirm that, by national standards, Southend has been underfunded over a long period. It is one of the intentions of the reforms that will come in next April that we achieve a fairer distribution of funding around the country. That will not happen overnight, but it is our clear intention that it should happen over a reasonably short period.

Is my hon. Friend aware that it is not an inspection that is needed, nor even an admission that our district has been underfunded for many years past? We want some action.

My right hon. Friend has an Act on the statute book which sets in place the machinery that will allow funds to flow in the way in which he desires. Action is coming.

When we see it we shall believe it. Is the Minister aware that Southend, like in my area of Waltham Forest, is covered by the North East Thames regional health authority, that that authority has recently slashed its capital programme and that many important developments have been cut as a result? When will the Minister do something about increasing that capital programme for a change?

Since 1979 the NHS capital programme has increased by 57 per cent. in real terms. I wish that I could believe the hon. Gentleman when he says that he will believe it when he sees it. He has seen it for more than 11 years and apparently still does not believe it.

To ask the Secretary of State for Health what initiatives are being taken to promote a better quality of care for patients.

Better quality of service and care for patients is at the heart of the NHS reforms. Key ways of achieving that will be the devolution of responsibility to local level and agreements between purchasers and providers with clearly specified quality standards.

Is not my hon. Friend's response an eloquent testimony to this Government's commitment to the National Health Service at a time when an aging population and welcome medical advances mean that there is a great deal to be done? Is not that a contrast to the capital-cutting, hospital building programme-cutting Labour Government who used to be in power?

I thank my hon. Friend for his words. In the words of my right hon. Friend the Member for Castle Point (Sir B. Braine), we believe in action, not words, and in putting quality at the forefront of our plans for the health service. My hon. Friend will know that the scheme in his constituency is one of our national demonstration projects, focusing on quality. The children's out-patient department received £110,000 from the Department last year, once again making sure that the patient and the patient's family are at the forefront of health care.

Given that the Minister is trying to reduce junior hospital doctors' working hours and to improve patient care in that way—as well as the working environment—what will be the effect on that of the national initiative on the opting out of hospitals as they seek self-governing trust status? Will junior hospital doctors be more or less likely to enjoy better working hours and better working conditions?

I am pleased that the hon. Gentleman has referred to our determined effort to tackle once and for all the unacceptable problem of some junior hospital doctors working unacceptable hours—unacceptable to them and to patients. Although considerable progress has already been made, we are determined to see further action in the specialties, hospitals and grades where the difficulty persists. I assure the hon. Gentleman that hospitals that become NHS trusts will, of course, abide by the manpower arrangements that have already been established, not only for junior hospital doctors' working hours, but in order to achieve a balance and to meet the safety net requirements.

Does my hon. Friend concede that there are differing ideas among different patients about what constitutes quality of care, which often have nothing to do with medical care? Some patients want to be in a room by themselves, to have better food or not to be in a mixed ward. How are the proposals progressing that would allow patients to pay something towards achieving those objectives?

I greatly appreciate my hon. Friend's contribution. My hon. Friend the Under-Secretary of State recently announced an initiative to allow patients who wish to do so to pay for the extras that make such a difference to their patient care. I remind the House and my hon. Friends of the national quality exhibition that will take place in Birmingham in a fortnight, which will demonstrate practically the many quality initiatives which, above all, seek to make sure that patients, their wishes, interests and concerns will come first and be given the priority that they deserve.

Does the Minister accept that a key factor in achieving quality of care for all patients is ensuring that they get the treatment that they need when they need it? Is not the Minister aware that hospitals throughout the country, such as Westminster, are closing wards to all but emergency admissions because of shortage of money? The Minister says that the Government believe in action, not words when it comes to quality health care, but why do the action and the words mean offering cuts to the Treasury instead of saving services for patients who need them?

It is rich for the hon. Lady to refer to action, not words. The Conservative party has increased the number of in-patients, and out-patients, and increased the number of day cases. On all fronts, there has been an improvement in the health service, leading to better patient care. However, we want to ensure that we continue to see perinatal mortality at a record low level, and that we see not only a reduction in the number of women dying from cervical cancer, but an increase in the number of coronary artery bypass grafts and kidney treatments. That is why my right hon. and learned Friend the Secretary of State announced last week a programme of health targets to ensure that we continue to focus our efforts on clear, concrete and practical achievements and continue to build a better health service.

Does my hon. Friend accept that one group of patients has, tragically, received bad care? I am referring to the haemophiliac AIDS victims. Does she further accept that if the Government believe in action, not words, we cannot be satisfied with the response that we have received so far?

I understand my hon. Friend's words. He will have heard my hon. Friend the Under-Secretary of State in last night's debate. The fact is that there was no case of neglect in those cases. However, we accept the great tragedy and that is why such significant resources have been made available to the families, who were so grievously affected, amounting to an average of £28,000 each. However, we cannot expect that every time there is a tragedy in the health service, when there is no professional neglect, there will be instant compensation, because the implications for us all and for all health care would be enormous.

To ask the Secretary of State for Health if he will make a statement on the progress made on public consultation following proposals for the formation of self-governing hospital trusts.

A total of 66 units have applied to become national health service trusts in the first wave, which will become operational in April 1991. Regional health authorities are currently consulting on applications from potential trusts within their regions. I shall announce my decision on each application after I have had an opportunity to consider the outcome of the public consultation.

The Minister will be aware that Newcastle Royal Victoria infirmary is preparing for self-governing trust status in 1991. Is he further aware that in the run-up to 1991, 50 per cent. of children's surgical beds are to be closed for an indefinite period, thus denying a three-month-old baby in my village the chance of major surgery? Will the Minister confirm that the cash crisis in Newcastle Royal Victoria infirmary and the bed closures are part and parcel of a softening-up exercise to enable the infirmary to opt out easily next year?

Newcastle Royal Victoria infirmary is an extremely successful hospital, which, together with the other hospitals in Newcastle, is expanding the service, and has been doing so rapidly during recent years, thus consuming additional resources. I believe that it is the location of one of the biggest building sites in Newcastle, where the next phase of development is being financed at present. It is most unfortunate that some people in Newcastle, who are surrounded by an expanding and improving service, spend their time trying to make allegations about a part of the service where the health authority has chosen its priorities in order to live within the ever-increasing sum of resources allocated to it. Doctors, nurses and others in Newcastle have expressed an interest in having more control over their own affairs. I am now considering the application in the light of the public consultations.

My right hon. and learned Friend is fighting hard for additional funds for the national health service in his negotiations with the Treasury, about which I am delighted. Can he assure me that he is fighting for additional funds for the whole of the national health service, not just for hospitals that are prepared to put in a submission for self-governing status?

Of course, I am buoyed up by my hon. Friend's support for my current negotiations, and am glad to have him on my side. The Government's duty is to ensure that funds are available to carry out the policies to which we are committed. We have to equate that with the need to keep down inflation, which we have done successfully in previous years. The past two public spending rounds have increased the cash available to the national health service by 20 per cent.—a better two-year record than any Labour Secretary of State could ever claim or would ever be likely to claim. My hon. Friend will have to wait to see what happens in the third year.

Did the Secretary of State see last week's survey in Tory Sutton and Cheam, which found that among 6,000 residents there was a majority against the local application of six to one? As the Secretary of State cannot carry Sutton and Cheam, would he care to name to the House a single poll of the public that has come out in support of his proposals?

Those surveys are usually carried out on the back of extremely misleading propaganda put out by organisations financed by the Labour party and trade unions. I am considering serious applications by those who work in the hospitals and public consultations that address the issues, not the allegations about opting out of the national health service and other nonsense disseminated by the Labour party. The hon. Gentleman must know perfectly well from his personal experience that there is considerable enthusiasm among the staff and those closely involved in many of the applications for self-governing status. I shall judge them all on whether I believe that those attractive plans can be successfully carried forward to improve the service to patients.

Is my right hon. and learned Friend aware that the consultation documents are full of information about how the various trusts will provide the capacity to fill up the hospitals, but are less informative about how they will actually achieve that? Will he ensure that any representation that is received and accepted contains a fulsome part showing how the extra resource will be made available?

I am glad that my hon. Friend is studying the application documents, which is more than most people are doing who are organising local straw polls up and down the country. As my hon. Friend will know, the success of any hospitals in the new national health service will depend on the quality of care that they achieve, the quality of service that they give to GPs and patients and their ability to lag referrals. Some of the applications for self-governing status come from the finest hospitals in the country and they are confident that if they are given more chance to run their own affairs, free from the old bureaucracy, they will attract more patients and resources under the new system.

To ask the Secretary of State for Health if he will make a statement on his proposals for taking action against cholesterol-related problems, in the light of the responses he has had to the document of the departmental working party paper on cholesterol.

The report from the standing Medical Advisory Committee was widely circulated with an invitation to respond by 31 October. When those responses are received, I shall be in a position to consider what action may be needed.

Since coronary heart disease kills about 143,000 people in this country, putting us very near the top of the league, over what period will the £25 million announced by Lady Hooper be spent in relation to cholesterol blood-related problems?

The hon. Gentleman may have heard my right hon. and learned Friend announce last week that he was intending to set up a portfolio of health targets, arid he identified coronary heart disease as a specific target: he wanted a 25 per cent. reduction in premature deaths associated with coronary heart disease by the year 2000. The amount of money that the hon. Gentleman identifies will clearly be used towards the achievement of that objective.

To ask the Prime Minister if she will list her official engagements for Tuesday 16 October.

This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today. This evening I hope to have an audience of Her Majesty the Queen.

May I ask the Prime Minister a question of which I gave her office notice earlier today? Will she take this opportunity to condemn Pol Pot and the Khmer Rouge for the mass murder of more than 1 million innocent Cambodians; and will she tell the House what action she and the Government are taking to stop Pol Pot and his allies marching back to power so that they can murder still more millions of innocent Cambodians?

I am grateful to the hon. Gentleman. We have repeatedly made clear our utter abhorrence for the Khmer Rouge and all that it stands for. We have never given support of any kind to the Khmer Rouge. Our aim over many years has been to prevent a return to the atrocities of the Pol Pot years, and, as a permanent member of the United Nations Security Council, we are working to achieve that through a comprehensive political settlement.

Does my right hon. Friend agree that those of us who seek to prevent the return of the Khmer Rouge should wholeheartedly support the Supreme National Council which has now been established, comprising both internal and external Khmers, and that we should wholeheartedly support the comprehensive political settlement which, in annex 2, deals with disarmament, with mines, with caches of weapons, with the return of refugees and with free elections? Does she further agree that, as the British Government recognise neither the external Khmers nor the Hun Sen regime as a legitimate Government, we should talk equally to both sides?

I am grateful to my hon. Friend. I agree with him that we should support the efforts of the five permanent members of the Security Council. This is another example of the five permanent members working very closely together. The Supreme National Council includes Hun Sen, Prince Sihanouk, Sonn San and the Khmer Rouge—those are its components. I agree with what my hon. Friend said.

On the exchange rate mechanism, does the Prime Minister recall that on 20 September she was adamant, in her own words, that

"the Madrid conditions won't be changed and they include getting inflation near to the European average"?

The right hon. Gentleman will have heard what my right hon. Friend the Chancellor said in his excellent statement. Several conditions were laid out in the Madrid statement. A number of them had been fully achieved; some others were on the way. The most important was progress on the free movement of capital; the next, progress on free trade in financial services; the next, progress on the single market and further progress in competition policy. Monetary conditions here made possible a reduction of 1 per cent. in interest rates. Yes, we could have gone on further and waited until inflation had visibly come down, but so many of the conditions had been met and there was so much speculation about when we were going into the exchange rate mechanism that we took advantage of the excellent opportunity—[Interruption.]

Order. These are very important matters.

—of the excellent opportunity of monetary conditions' coming within their limits to end all the speculation about when we should go in and go in, just one year after we had increased interest rates to 15 per cent., just before the Tory party conference.

If the Prime Minister is so confident about her judgment, why will she not simply come to the House next week and speak in the debate? Is not it now obvious that her own personal position on this issue is utterly impossible to justify, and that she is just plain frit?

Unlike the right hon. Gentleman, I have a most excellent Chancellor, an excellent Treasury team and a superb—[Interruption.]

Order.

—and a superb Secretary of State for Trade and Industry. I shall be here answering questions every Tuesday and Thursday, and I hope that one day the right hon. Gentleman may know how to ask a good one.

Does my right hon. Friend agree that a responsible policy on the environment must be both practical and realistic, and that to insist on the reduction of CO₂ emissions around the turn of the century, while at the same time discounting the future use of nuclear power, increasing the use of fossil fuels such as coal and promoting cheaper petrol, makes no sense whatever? Does she agree that that policy is highly environmentally damaging as well?

I agree with my hon. Friend. If one wants to reduce emissions of carbon dioxide, one of the best ways is to support nuclear power. Recently we have also seen a substantial increase in the price of oil and petrol, without attempting to put it up further. Any promises that are made should be capable of being fulfilled, and the earliest date on carbon dioxide emissions when we can fulfil this promise is the year 2005.

To ask the Prime Minister if she will list her official engagements for Tuesday 16 October.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Does the Prime Minister agree that the honourable and decent way forward in the tragic case of the 1,200 haemophiliacs suffering from the AIDS virus is to offer far more generous compensation than has been the case up to now, rather than continuing to fund ever-increasing fees for lawyers to argue the toss over the matter?

The Government have already made available some £34 million to the haemophiliacs who are suffering from this very grievous happening, as an ex gratia payment without prejudice to their taking legal action in the courts. Obviously, we wish to know the legal position before any further payment is considered.

Has my right hon. Friend had time to notice British Rail's 25 per cent. pay offer to its track-laying and signalling staff? Does she agree that pay awards of that order will merely outrage fare-paying passengers, stoke up inflation and put off further the day when we can reduce interest rates still more?

If my recollection is correct, certain recommendations about signalling were made after the Clapham accident that must be taken into account when one judges that settlement. I am sure that my hon. Friend would agee that it is absolutely vital that we live up to the safety standards required of us by the report following that terrible accident.

To ask the Prime Minister if she will list her official engagements for Tuesday 16 October.

I refer the hon. Lady to the reply that I gave some moments ago.

Does the right hon. Lady remember saying 15 months ago that lowering United Kingdom inflation was the most important of the Madrid conditions? If that is no longer the case, when and why did she begin to change her mind and decide that the right hon. Member for Blaby (Mr. Lawson) was right?

Had the hon. Lady listened yesterday and earlier this afternoon, she would have heard the Chancellor and I both say that a large number of the conditions had already been met and that there was an opportunity to go into the exchange rate mechanism. We took that decision and it was right. It has been warmly welcomed and I am amazed that Opposition Members are being so small minded about it. Did not they want us to go in?

Many hon. Members know the Kuwaiti ambassador, but not many know that three weeks ago his brother-in-law was seized by the Iraqi forces, taken away and tortured for 16 days, and then taken back to his home to be executed in front of his house and family. Will my right hon. Friend assure the House that people who perpetrate such crimes will not escape punishment?

We all share the revulsion that has been expressed about that brutal act and we have seen the Amnesty International report about many other brutal acts conducted daily by Saddam Hussein in Kuwait. That makes it clear that we must deal with this man. I agree with my hon. Friend that he must be made answerable for these terrible crimes and must withdraw from Kuwait so that the legitimate Government of Kuwait can be restored. I join my hon. Friend in sending our sympathies to the Kuwaiti Government on this terrible brutality.

To ask the Prime Minister if she will list her official engagements for Tuesday 16 October.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Is the Prime Minister aware of the indignation and outrage felt by Cypriots in my constituency about the Government's two-faced attitude to invasions? Troops have been sent to Saudi Arabia as a result of the invasion of Kuwait, but absolutely nothing has been done about the Turkish invasion of Cyprus. Is the Prime Minister—[Interruption.]

Order. Mr. Grant.

Is the Prime Minister aware that the international financial bandit Mr. Asil Nadir and his company, Polly Peck, have made their money by stealing property, orange groves and hotels from Greek Cypriots who are living in exile in my constituency? Will she do something—[Interruption.]

Order. This House is for putting forward views that hon. Members feel strongly about. We have a right to do that.

What will the Prime Minister do to prevent this carpetbagger, Mr. Nadir, from bringing his money, his ill-gotten gains, out of the north of Cyprus into this country in order to bail out his company, Polly Peck?

Perhaps the hon. Gentleman has forgotten that the events in Cyprus that led to the Turkish invasion and the toppling of Makarios happened during the lifetime of a Labour Government and the decision not to invoke the guarantee was that of the then Foreign Secretary who is now the noble Lord Callaghan. The hon. Gentleman will be fully aware that we wish to see the state of Cyprus continue bi-zonal and bi-communal and that we fully support the efforts of Mr. Perez de Cuellar, the United Nations Secretary-General, to bring that about. The hon. Gentleman knows full well that the matters that he raised in the latter part of his question are under investigation by the serious fraud squad.

Will my right hon. Friend comment on the recent press interview given by the general commanding the British forces in the Gulf, in which he said that he expected that further British troops who are still under training would be deployed in that area? Does my right hon. Friend agree that while that policy may well be welcome and right, it would be preferable for such anouncements to be made in the first place in Parliament?

My hon. Friend is aware that the full armoured brigade is on its way there. I know of no intention to send any further people. Obviously, the brigade goes with its full support staff, including the engineers and the full hospital staff, which is not the 8,000 of the armoured brigade but about 11,000 in all. That is a part of the support for the armoured brigade.

To ask the Prime Minister if she will list her official engagements for Tuesday 16 October.

I refer the hon. Gentleman to the reply that I gave some moments ago.

Is the Prime Minister aware that 39 countries have now ratified the United Nations convention on the rights of the child? When will this country ratify those excellent terms? What are we waiting for?

I signed the convention on behalf of the United Kingdom when I was at the United Nations; to ratify it, it would have to come before the House.

Is my right hon. Friend aware that Mr. Tony Wilbraham, a Baghdad hostage and father of my constituents Joanne and Paul, could die as soon as Christmas from advanced lung cancer? Will she do all that she can to secure his early release together with that of his wife, who is standing by him and nursing him, and of other sick hostages who, so far, Saddam Hussein has not had the compassion to release?

We have every sympathy with Mr. Wilbraham and his family and also with the others who are suffering from terminal illnesses and being so wickedly detained by Saddam Hussein. It shows the true nature of that person. As my hon. Friend knows, our ambassador is still in Baghdad, and he is making strenuous efforts to ensure that those people are released. We utterly condemn Saddam Hussein for not releasing them.